EA181913 - Plumbing - Single Fam - Issued Date 03/27/2023 PERMIT
City of Eagan Permit Type: Plumbing
3830 Pilot Knob Rd •-%1
% ;:, Permit Number: EA181913
Eagan,MN 55122 •-•• ---•
EAGAN
(651)675-5675 111111111111
www.cityofeagan.com * E R 1 8 1 9 1 3
Date Issued: 3/27/2023
Site Address: 2124 Shale Lane
Lot: 13 Block: 7 Addition: Cedar Grove 4th
PID:10-16703-07-130 111111111111 IN 11111111111111111111111111111111111111111 IN 111111 1111M
Use: * 1 0 — 1 6 7 0 3 — 0 7 — 1 3 0
Description:
Sub Type: Single Fam
Work Type: Alteration
Description: Bathroom(s)
Meter Size Meter Tyne Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-Plumbing Permit Fee $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: Owner: - Applicant -
Valerie Lois Domeier
2124 Shale Lane
Eagan MN 55122
This permit shall be null and void if work does not start within 180 days of issuance,or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature ssued B : Signature
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1 • I For Office Use
e • • • I '
� �, e • �• � I Permit#: I
EAGAN 1
Permit Fee: I
I
I
Date Received: I
3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810 I j
(651)675-5675 l FAX:(651)675-5694 I Staff: I
buildinctinspections(&-cityofeagan.com I-----------------'
RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 3/23/2023 Site Address: 2124 Shale Lane Eagan MN 55122 Unit M NA
Applicant Is: 0 Owner ❑ Contractor
Name: Patrick&Val Domeier
Homeowner Address: 2124 Shale Lane City: Eagan
State: MN ZIP: 55122 Phone: 6127152550 Email: Paul.domeier.hk@gmail.com
Type of Work —New —Replacement —Repair —Rebuild —Modify Space —Work in R.O.W.
Description of work: Basement Finishing
Tankless Water Heater
Standard Water Heater Lawn Irrigation(—RPZ/—PVB)
Description Water Softener l� Add Plumbing Fixtures( Main/✓Lower Level)
septic system Description: basement bathroom finishinq
New Abandonment Connection to City Water from Well
Company: Contact:
Plumbing Address: City:
Contractor
State: Zip: Phone: Email:
License M Expiration Date:
RESIDENTIAL FEES
$150.00 New Residential or Connection to City Water(includes State Surcharge)
$65.00 Water Heater,Water Softener,or Water Heater and Softener(includes State Surcharge)
$65.00 Lawn Irrigation(includes State Surcharge)
$65.00 New fixtures,adding,altering,or removing piping(includes State Surcharge)
$65.00 Septic System Abandonment(includes State Surcharge)
TOTAL FEES$
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.aopherstateonecall.orct for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
I hereby acknowledge that this Information is complete and accurate;that the work will be In conformance with the ordinances nd codes of the City of
Eagan; that I understand this Is not a permit, but only an application for a permit, and work is not to start without a pe ;that the work will be In
accordance with the approved plan In the case of work which requires a review and approval of plans.
XPatrick Paul Domeier X
Applicant's Printed Name ppllcant's gnat
FOR OFFICE USE
Reviewed By: Date:
Meter Size(if applicable):
Required Inspections: Under Ground Rough-In Air Test Gas Test Manometer Final